Adult and Pediatric Targeted Temperature Management – BD ArcticSun™
Targeted Temperature Management in Adult and Pediatric Patients – BD ArcticSun™ 5000
Targeted temperature management (TTM) means bringing the patient's body temperature to a planned target and keeping it there: hypothermia in some patients, fever prevention and controlled normothermia in others, and controlled rewarming after surgery in yet others. Current adult guidelines emphasize fever prevention and recommend continuous core temperature monitoring together with, if a device is used, a feedback-controlled (servo-controlled) device. BD ArcticSun™ 5000 delivers this treatment with non-invasive ArcticGel™ pads in adult and pediatric patients of all ages.
This page is intended for healthcare professionals. Treatment decisions and targets are determined by the physician; please refer to the product's instructions for use for detailed information.
Emergency and intensive care: after cardiac arrest
- AHA 2025: In adults who do not follow commands after cardiac arrest, temperature should be controlled between 32–37.5 °C for at least 36 hours; rewarming after hypothermia should not exceed 0.5 °C per hour.
- ERC-ESICM 2025: Fever should be prevented (below 37.7 °C) for at least 72 hours in comatose patients; there is insufficient evidence to recommend for or against a 32–36 °C target.
- Prehospital cooling with cold intravenous fluids is not recommended; temperature control is initiated in hospital.
- Neurological prognostication should be performed after normothermia is achieved, after sedation is stopped, and no earlier than 72 hours.
In the catheterization laboratory: ArcticSun does not require an intravascular catheter; femoral and venous access remains available for PCI, ECMO and mechanical support. The pads are compatible with X-ray imaging. Emergency angiography is a guideline recommendation in patients with ST elevation and an individual decision in others; temperature control should not delay this process.
Neurological and neurosurgical intensive care
Fever is common in patients with acute brain injury; by increasing the brain's metabolic demand and intracranial pressure, it contributes to secondary brain injury.
- Traumatic brain injury: According to the ESICM and NACCS 2024 consensus recommendations, temperature should be monitored continuously and fever treated promptly; controlled normothermia at 36.0–37.5 °C is recommended in the management of intracranial pressure.
- Stroke, intracerebral hemorrhage and subarachnoid hemorrhage: In the international randomized INTREPID trial (JAMA, 2024), temperature control at 37.0 °C with ArcticSun reduced the time patients spent with fever compared with standard care (9.0 vs 21.6 hours); however, there was no difference between groups in functional outcome at day 90, and shivering was more frequent in the device group.
- Shivering management: Shivering is the most common side effect of temperature control and should be managed with a protocol. ArcticSun's heat production indicator helps detect shivering early.
Cardiovascular surgery: controlled postoperative rewarming
Patients frequently arrive in the intensive care unit hypothermic after cardiopulmonary bypass. After separation from bypass, core temperature may fall again as heat redistributes from the warm core to the cold periphery (after-drop). In an observational study of 5,701 coronary bypass patients, arriving in the intensive care unit below 36 °C was associated with higher mortality, longer mechanical ventilation, more red blood cell transfusion and a longer length of stay (Insler et al., Ann Thorac Surg 2000). Rewarming too quickly and fever after rewarming are also undesirable.
- ArcticSun brings the patient to normothermia at an adjustable rate of 0.05–0.5 °C per hour and maintains it in normothermia mode; if fever develops, it switches to cooling.
- Rewarming, cooling and maintenance of normothermia are performed with the same device.
- The pads are applied to the torso and thighs; placement is planned according to the surgical site.
- Aortic surgery requiring deep hypothermic circulatory arrest (DHCA), postoperative cardiac arrest and patients who develop neurological complications are also considered in this group.
Pediatric intensive care
In children, cardiac arrest is most often of respiratory or hypoxic origin; the developing brain is more susceptible to secondary injury, and because of a large body surface relative to weight, temperature can change rapidly.
- After cardiac arrest: According to the ILCOR 2026 draft recommendations, active temperature management should be applied in comatose children and temperatures above 37.5 °C should be prevented; the total control period is 120 hours. No difference in outcome has been shown between 32–34 °C and 36–37.5 °C targets (THAPCA); the main message is to avoid fever.
- Traumatic brain injury: Normothermia (36–37.5 °C) is the primary early target.
- Pediatric cardiac surgery and ECMO: Controlled postoperative rewarming and maintenance of normothermia; continuous temperature control under ECMO against the risk of both hypothermia and hyperthermia.
- In a treatment lasting up to 120 hours, servo control provides the same precision day and night and reduces the nurse's manual adjustment workload.
Clinical evidence: ArcticSun and hydrogel pad technology
- Mayer et al., Crit Care Med 2004 (randomized, n=47): In febrile patients in the neurological intensive care unit, ArcticSun reduced fever burden by 75% compared with a conventional cooling blanket; time to target was 2.4 vs 8.9 hours. Shivering was more frequent in the ArcticSun group (39% vs 8%); this was a small, open-label, single-center study.
- Glover et al., Crit Care 2016 (TTM trial sub-analysis, n=934): No significant difference in mortality or neurological outcome was found between surface and intravascular temperature control.
Limitations of the evidence: Routine hypothermia at 33 °C was not found to be superior to normothermia with fever prevention (TTM2, NEJM 2021). Hypothermia is not a routine indication for reducing infarct size in cardiogenic shock and STEMI. The target temperature and duration are determined by the physician for each patient.
A pad for every patient
- 2.5–16 kg: 1–3 small universal pads
- 16–30 kg: XXS · 31–45 kg: XS · 44–57 kg: Small pad kit
- 57–73 kg: Medium · 73–100 kg: Large pad kit
- Over 100 kg: Large pad kit + universal pad
For effective treatment, 30–40% of the body surface should be covered with pads.
Training and support
Prizma-Med provides installation, development of institutional protocols, physician and nurse training, ArcticGel™ pad supply and technical service support. For requests: +90 342 360 64 50 · info@prizmamed.com.tr
Related pages: BD ArcticSun 5000 · Hypothermia system for neonatal HIE · Frequently asked questions about hypothermia treatment (TTM)